Provider Demographics
NPI:1003048687
Name:KOLLU, VIDYA SAGAR (MD)
Entity type:Individual
Prefix:
First Name:VIDYA
Middle Name:SAGAR
Last Name:KOLLU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 NW 136TH TER
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0229
Mailing Address - Country:US
Mailing Address - Phone:408-836-3984
Mailing Address - Fax:
Practice Address - Street 1:500 NW 43RD ST STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6126
Practice Address - Country:US
Practice Address - Phone:352-378-9100
Practice Address - Fax:352-278-9005
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14878207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease